Archive for September, 2010

In the US we punish unethical or incompetent doctors by taking away their license (a matter regulated at the state level). In the UK doctors are punished by being “struck off” the register of physicians. You may recall that the infamous Andrew Wakefield was struck off for ethics violations related to his MMR-autism Lancet study.

Now we have news of another UK physician being struck off – this time for prescribing stem cell treatments for multiple sclerosis (MS) patients. Dr. Robert Trossel was found by the General Medical Council (GMC) to have breached good medical practice by “exploiting vulnerable patients.” He gave stem cell treatments to several patients with MS, at a cost of about £10,000 each.

Thankfully, NeuroLogica is working again, our bandwidth has been widened, WordPress has been tweaked, and I’m looking forward to getting back to my regular schedule of blogging (Thanks to Mike Lacelle for his hard work getting everything online again.)

I thought I would start with this item regarding science education in the US – Report: Poor science education impairs U.S. economy. It’s yet another depressing report about the sad state of science education. The US is also not alone – the UK is considering gutting support for science, and other countries are lagging as well.

The generally accepted version of history is that in the 1950s, following Sputnik, nationalism and fear of competition from the USSR spawned an era of heavy investment in science, technology, engineering, and math (STEM). This ultimately resulted in the science and technology boom in the US in the following decades.

NeuroLogica has been down for a few days – sorry for the inconvenience. The site has become too slow to use. But, the good news is we have now migrated over to a high end host with vastly increased resources, and so performance should be better than ever. I will resume my normal schedule of blog posts soon – so stay tuned.

Just published in the British Medical Journal (BMJ), a meta-analysis of glucosamine and chondroitin for osteoarthritis involving 10 trials and 3803 subjects – showing no benefit for either, separately or in combination. These supplements, like so many that have gone before them, are little more than expensive placebos.

Glucosamine and chondroitin are among the most popular supplements, and the most popular for osteoarthritis. The theory is that these substances, which are made naturally in the body, are used to build cartilage, the smooth substance that lines joints and breaks down with age and wear and tear. This theory, however, has always been weak. It suffers from the same faulty assumptions of many supplements – that if little is good, more is better; that dietary sources of these substances are inadequate and that the biological processes that use them are limited by availability of this raw material. None of these assumptions are likely valid.

First, for many substances in the body (vitamins, minerals, etc.) there is likely an optimal range of intake, not a linear relationship where more is always better. This is generally what we find when we examine biological systems. So taking supplements to increase the amount of a nutrient is as likely to cause harm as good. This point may not be as relevant to building block nutrients like glucosamine and chondroitin as to cofactors like most vitamins, however.

though a little past the time of your debate with homeopaths at the University of Connecticut Health Center: A Debate: Homeopathy – Quackery Or A Key To The Future of Medicine? (2007), i’m wondering why in your response to the actual debate on your blog you respond in the comments section to a post:

“The bottom line is that homeopathy is a tangle of magical thinking, every element of which lacks a theoretical or empirical basis.”

i’m unsure how you can make this statement when Dr. Rustom Roy disproved one of your main arguments, that homeopathic medicines are merely placebos, showed evidence that the structure and thus function of water can be changed for extended periods of time. this evidence presented refutes that the remedies are merely water, the inert substance that we all think it is. your quote above entirely ignores and contradicts the evidence that was shown to you.

One of the major themes of scientific skepticism is – know thyself, specifically the many frailties and foibles of human cognition. Skeptics generally hold that the many anecdotes of strange experiences, sightings, abductions, encounters, and healings are not evidence of a paranormal world lurking beneath the physical world, but rather evidence of our flawed thinking, memory, and perception. The scientific evidence overwhelmingly supports the latter, rather than the former, hypothesis.

Memory by itself is a sufficient explanation for many apparent anomalies. Our memories are not an accurate recording of the past. They are constructed from imperfect perception filtered through our beliefs and biases, and then over time they morph and merge. Our memories serve more to support our beliefs rather than inform them.

I file this one under, “what the hell was he thinking?” The Irish Minister for Science had planned to attend the launching of an anti-intellectual, anti-scientific ignorant rant in book form and apparently did not see any problem with this until he was widely and publicly criticized. Then he withdrew – at the request of the author, it is rather dubiously claimed.

Conor Lenihan, the Minister of Science, wanted to support his friend and constituent, John May. Apart from being the leader of the V-resistance, May is also the author of a book called The Origin of Specious Nonsense, in which he calls evolution, “A Hoax”, “A Joke”, “A Fantasy”, “An Impossibility”, “A Fiction”, “A Fairytale For Adults”, “The greatest deceit in the history of science.” May’s book is a triumph of ignorance over information (more on that below).

Lenihan’s support for this book is nothing short of a Scandal. First, he is the Minister of Science and it is profoundly naive of him to think that he can personally support a book like May’s and separate his personal support from that of his office. Officials make this mistake all the time, and frankly I always have a hard time believing that they believe it. Rather I think it is either intellectually lazy or disingenuous. Those on the fringe are desperate for validation, and they will grasp at any apparent validation to promote themselves. So when a university sponsors a talk, the reputation of that university will be invoked to support the speaker. When an official recognizes the existence of a crank, that crank will use that recognition as official support. When a new program showcases a nutjob, that news program will forever be emblazoned on the nutjob’s website.

No one study can ever be definitive, but now we have a large body of evidence from multiple studies showing a lack of association between thimerosal and autism. This won’t stop the dedicated anti-vaccinationists and mercury militia from continuing their anti-vaccine propaganda, but hopefully it will further reassure those who actually care about the science.

Background

This has been a long and complex story, so let me review some of the background. Diagnosis rates of ASD have been climbing for the last 20 years, prompting some to search for an environmental cause. The existing anti-vaccine community, not surprisingly, blamed vaccines. This was given a tremendous boost by the now-discredited study by Andrew Wakefield concerning MMR (which never contained thimerosal) and autism. When the evidence was going against MMR as a cause, attention turned to thimerosal in some vaccines. This notion was popularized by journalist David Kirby in his book, Evidence of Harm.

As you might imagine, I am fascinated by how the mind works. It is, arguably, the most important thing to each of us – our own brain. We are our brains. It is our universal tool, the one tool to rule them all. And so understanding the strengths and weaknesses, the quirks and foibles of the human brain in general, and our own brains in particular, should be of paramount interest.

One aspect of brain function that is very interesting is how we model abstract concepts in our brain, like numbers. We often assign physical properties to abstract concepts, perhaps as a handle so that we can better think about them. For example, with numbers we tend to picture them spaced out along a line, with linear distance being proportional to number value. We put numbers into a physical space. An extreme example of this in number synesthesia – some people actually feel that numbers have a shape, color, or texture. In some cases they use these properties of numbers to help them do calculations in their heads.

A recent psychological study looked at the number line of children. Young children just learning numbers tend to have a logarithmic number line, with low numbers spaced out and higher number increasingly squished together. But as children mature their number line tends to become more linear, with spacing being proportional to value. The recent study asked children to place various numbers on a line where they belong, to see what their mental number lines look like. They then gave them a mental task that required remembering numbers. What they found was that the more linear the child’s number line, the better they performed on number memory tasks.

A new study in PLOS One looks at the effects of taking three B vitamins (folate, B12, and B6) on mild cognitive impairment (MCI). They found that taking these B vitamins over a two year period was associated with a decreased rate of brain atrophy as determined by MRI scanning. Although this is a small study, this is an interesting result that certainly requires further study.

For background, MCI is a common syndrome – affecting 14-18% of those over 70. It is marked by poor memory, concentration, and ability to learn new information, although not severe enough to qualify for a diagnosis of dementia or Alzheimer’s disease (AD). However, 50% of those with MCI do go on to develop Alzheimer’s type dementia. It should be noted that MCI is a clinical syndrome, defined only by symptoms not by underlying cause. Alzheimer’s type dementia is also a clinical syndrome, essentially the presence of dementia without a reversible cause. Alzheimer’s disease is a pathological entity, and requires brain biopsy or autopsy to diagnosis – you need to look at brain under a microscope.

This is a study of MCI, not Alzheimer’s disease. But not surprisingly the popular press is reporting this as a potential treatment for Alzheimer’s disease – that is simply incorrect. This may have implications for AD, but that was not studied.